Epileptic seizures in patients following surgical treatment of acute subdural hematoma - incidence, risk factors, patient outcome and development of a new scoring system for prophylactic antiepileptic treatment (GATE 24-score).

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Epileptic seizures in patients following surgical treatment of acute subdural hematoma - incidence, risk factors, patient outcome and development of a new scoring system for prophylactic antiepileptic treatment (GATE 24-score).

World Neurosurg. 2017 Feb 14;:

Authors: Won SY, Dubinski D, Herrmann E, Cuca C, Strzelczyk A, Seifert V, Konczalla J, Freiman TM

Abstract
OBJECT: Clinically evident or subclinical seizures are common manifestation in acute subdural hematoma (aSDH); however, there is a paucity of research investigating the relationship between seizures and aSDH. The purpose of this study is, firstly to determine incidence, predictors of seizures and secondly establish a guideline in patients with aSDH to standardize the decision for prophylactic antiepileptic treatment.
METHOD: The author analyzed 139 patients with aSDH treated from 2007 until 2015. Baseline characteristics and clinical findings including Glasgow coma scale (GCS) at admission, 24 hours after operation, timing of operation, anticoagulation, Glasgow outcome scale (GOS) at hospital discharge and after 3 months were analyzed. Multivariate logistic regression analysis was performed to detect independent predictors of seizures and a scoring system was developed.
RESULTS: Of 139 patients, overall incidence of seizures was 38%, preoperatively 16% and postoperatively 24%. Ninety percent of patients with preoperative seizures were seizure-free after operation for 3 months. Independent predictors of seizures were GCS < 9 (OR 3.3), operation after 24 hours (OR 2.0) and anticoagulation (OR 2.2). Patients with seizures had a significant higher rate of unfavorable outcome at hospital discharge (p=0.001) and in 3 month follow-up (p=0.002). Furthermore a score system (GATE-24) was developed. In patients with GCS < 14, anticoagulation or surgical treatment 24 hours after onset a prophylactic antiepileptic treatment is recommended.
CONCLUSION: Occurrence of seizures affected severity and outcomes after surgical treatment of aSDH. Therefore, seizure prophylaxis should be considered in high-risked patient based on GATE-24 score to promote better clinical outcome.

PMID: 28213197 [PubMed - as supplied by publisher]

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